Panic attacks and panic disorder in athletes: diagnostic challenges, exercise-related physiological symptoms, and clinical implications

Abstract

Background. Panic attacks and panic disorder (PD) in athletes remain poorly characterised. Their assessment is complicated by the overlap between panic symptoms and physiological responses to intense exercise.

Aim. This narrative review summarises current evidence on epidemiology, interoceptive mechanisms, diagnostic challenges, clinical consequences, and management.

Materials and Methods. PubMed and Google Scholar were searched, primarily for studies published in 2020–2026; older relevant studies were also included. Athlete-specific evidence was prioritised, with general-population studies used where necessary.

Results. Epidemiological evidence is sparse and heterogeneous, and estimates still rely on a few earlier studies. Exercise-related sensations may be catastrophically interpreted in PD and contribute to avoidance, but may also have therapeutic value through interoceptive exposure. Differential diagnosis should consider respiratory and cardiac conditions, and screening should complement rather than replace clinical assessment. Treatment generally follows established PD approaches, including cognitive behavioural therapy and pharmacotherapy, but direct evidence in athletes remains scarce. Treatment decisions should account for potential effects on safety and functioning during training and competition.

Conclusions. Further athlete-specific research using standardised diagnostic approaches is needed to evaluate diagnostic and treatment strategies adapted to sport.